1. Neurofeedback Betty Jarusiewicz, PhD, CADC Atlantic Counseling Center, Inc Atlantic Research Institute, Inc The Lighthouse Network, Inc Atlantic Highlands, NJ 732-872-8700 732-801-4505 E-mail: bjarus@comcast.net www.autism-home.com

2. Contents Background/Overview –What is Neurofeedback/Neurotherapy/EEG Biofeedback/How it Differs From Biofeedback –Types/Frequency Ranges/Uses/With Other Therapies Research Basis (Thumbnail sketch) Why NT Works –Theory –Measurements

3. Contents (cont’d) Delivery of NT –What it looks like –Places of NT Delivery/Types of Measurement Clinicians Other Therapists Home Schools Our Research –Autism Efficacy –School Pilot –General Experience Data

4. Background Other Names –EEG Biofeedback –Neurotherapy (NT) –Neurotraining (NT) How it Differs from Biofeedback

5. Background: What is Neurofeedback and What does it do ? (Neuroregulation) the process of operant conditioning which changes one’s state (stabilizes CNS) and improves behavior using equipment that monitors and measures the electrical activity of the brain and TRAINS the brain to be more available to life’s requirements

6. Background: Types of Neurofeedback Beta/SMR –Eyes Open –Frequency Range 12-18 Hz Alpha/Theta –Eyes Closed –Frequency Range 0-11 Hz

7. Background - Terminology : Brainwave Frequencies (Brain States)

8. Some Documented Uses of Neurofeedback (in addition to Autism Study) (See www.isnr.org for Comprehensive Bibliography)www.isnr.org Beta/SMR –Epilepsy –ADD/ADHD –Sleep –Anxiety, Impulsivity - Depression Alpha/Theta (after Beta/SMR) –Emotional and behavioral instability –Addiction (Note: NFB is approved by FDA for relaxation)

9. Integration with other Therapies/Approaches Autism, Learning Disabilities, AD/HD, Epilepsy –Behavioral Therapies –Speech Therapies –Occupational Therapies –Counseling –Other (I.e. Assistive Learning) Headaches (Migraines), Sleep, Anxiety, Impulsivity, Emotional and Behavioral Instability –Counseling –Medication Addictions, Peak Performance –Counseling

10. Research Basis 1974: Sterman, MacDonald, & Stone –Noted: seizures reduced by 66% on 4 individuals –Used SMR combined with inhibition of excessive slow wave activity (6-9 Hz) 1976 SMR: Lubar – Hyperactivity Effects noted: –subsided during training for epileptic seizure reduction –reduced even in absence of seizures –More effective than stimulant medication alone

11. Research Basis (cont’d) 1984: Lubar –SMR,with inhibits technique extended to attentional deficits and learning disabilities –Significant academic performance enhanced by use of Beta (12-15 Hz) 1989: Penniston & Kulkowsky –Addition of Alpha Theta Work –Operant conditioning with eyes closed –For use in meditation and mental imagery –Useful for Addiction, PTSD, and Peak Performance work

12. Research Basis (cont’d) 1989 – Othmer –Initial work with Epilepsy –Development of Software/Hardware for Operant Conditioning Process –Development of EEG Spectrum Inc. –Expansion to other conditions, setting up protocols, training practitioners

13. Research Basis (Cont’d) To Date –Researchers per ISNR Bibliography) –Epilepsy: 37 –ADD/ADHD, Learning Disabilities, & Academic- Cognitive Enhancement: 63 –Anxiety Disorders, PTSD, & Sleep Disorders: 33 –Depression Hemispheric Asymmetry, Anger & Pre Menstrual Syndrome: 21 –Addictive Disorders: 15 –Brain Injury, Stroke, Coma, Spasticity, & Cerebral Palsy: 22

14. Research Basis (Cont’d) To Date –Researchers per ISNR Bibliography –Chronic Fatigue Syndrome, Fibromyalgia & Autoimmune Dysfunction 6 –Pain & Headache:11 –Schizophrenia: 3 –Obsessive Compulsive Disorder: 1 – Parkinson’s Dystonia: 1 –Tourettes Syndrome: 1 –Autism: 3 –Creativity & Optimal Functioning: 5

15. Research Basis (Cont’d) To Date – Researchers per ISNR Bibliography –Cognitive Decline with Aging: 2 –Hypertension: 1 –Dissociative Disorders: 2 –Tinnitus: 3 –Criminality: 1 –Adverse Reactions: 3 –Theoretical-Conceptual, Standards, & Review Articles: 14 –General Articles on Slow Cortical Potential Neurofeedback: 10 –Hemoencephalography (HEG): 5

16. Why Neurofeedback Works (Operant Conditioning) –Brain can change with assistance directed by rewards: light, movement, and sound –Brain assists in finding best/better approach (New pathways? More dendrites?) –Brain will remain in new state as it “feels better” –Brain is continually used, maintaining “new skill”

17. Base EEGs and States of Arousal With thanks to Harold Burke, Ph.D.

18. Normal Adult EEG (line 1) with subgroups of frequencies (low = line 2, medium = line 3, and high = line 4) With thanks to EEG Spectrum International, Inc and Harold Burke, Ph.D.

19. Female Age 7: Base EEG with Sub frequencies (Epileptic spikes/seizures and ADD) With thanks to EEG Spectrum International, Inc. and Harold Burke, Ph.D.

20. Male Age 5: Base EEG with Sub frequencies (Delta activity, ADD and CD) With thanks to EEG Spectrum International, Inc. and Harold Burke, Ph.D.

21. Male Age 8: Base EEG and Sub frequencies (High frequency activity, OCD) With thanks to EEG Spectrum International, Inc. and Harold Burke Ph.D.

22. Example of Similar Exercise Model Cardio respiratory Exercise –Stronger heart and improved regulation –Sleep improved –Mood improved –Lower basal metabolism With thanks to Harold Burke, Ph.D.

23. In Summary, EEG Biofeedback: Enhances the ability of an individual to access and maintain different states of physiological arousal and to navigate from high-vigilance to rest. (trains the brain to regulate itself better) Hence, the treatment of disorders, such as ADHD, depression, and anxiety. With thanks to Harold Burke, Ph.D.

24. Summary (cont.) Enhances and supports the mechanisms by which the brain manages cortical hyper excitability and promotes stability. Hence, stabilization against “minor” problems, such as temper tantrums, vertigo, tics, OCD, bipolar disorder, panic attacks, and PMS; and against even lesser disruptions, such as attention problems, sequential and parallel processing, and normal sleep.

25. Summary (cont.) Reinforces equilibrium states. Hence, normalization of pain thresholds, appetite, and blood glucose levels.

26. What about the Placebo Effect? The effects of the training are highly specific to electrode placement and to training frequency band. Training protocols exist which can commonly elicit effects opposite to those desired. The effects of training with one protocol can be reversed with another. With thanks to Harold Burke, Ph.D.

27. What Brain Training Sessions Look Like: Client “Hookup”

28. Universal 10 20 Chart for Electrode Placement

29. Brain Training Session Screens Therapist (EEG) Client (Game)

31. Therapist’s Screen Measurement of total EEG signal at the scalp with electrode or two Amplification of microvolt-level signals for computer processing; Extraction of low, medium, and high frequencies

32. How is it done? (cont.) Progress is monitored every session; Initial sessions should be at a rate of 2- 3 per week until progress is seen (probably by 20 sessions). Research study: B. Jarusiewicz

33. Control by Right and Left Brain* The left brain “Style”: Analytic -Speech/language specialization -Processing -Focus The right brain “Style”: Holistic –Superior visuospatial performance –Emotions/tension –Anxiety And Left Brain/Right Brain 5 th Ed 1998, Springer, S & Deutsch, G

34. Brain Frequencies “Spectrals” (Note: Every person is different) Autistic * Typical * (note extensive delta, theta and alpha frequencies)

35. Measurement of Change By Client –Establish changes client wishes to make –Develop reporting mechanism

36. Measurement of Change By Therapist –Review behavior changes (checklists, drawings) –Review how client feels –Review brain activity (measured averages etc) –Review spectrals

37. Child’s Family Drawing at Beginning of NF - 8/3/94 (with thanks to L. Hirshberg)

38. Drawing after Twenty Sessions - 9/8/94

39. Drawing after forty sessions - 11/25/94

40. ATEC Checklist (www.ari/atec.com)

41. Hill and Castro ADD/HD Checklist

42. Measurement of Change For Research –Use of “standard” tests (ADI, ADOS, Checklists, IQ, memory and reading) –Corroborative Evidence (videos, interviews, school or other therapy reporting tests)

43. Pilot Study Plan 24 Autistic Spectrum children chosen for pilot, 12 chosen to train, 12 as controls Matched: age, gender, level of autism All assessed with : Othmer Assessment, Rimland ATEC, Greenspan Video (15 min free play)

44. Description of Individuals Trained Ages: 4.4-13.2 years, average 6.8 years Gender: 11 males, 1 female Autism Spectrum Level (per ATEC): 26-118.5, average 65 Types of Impairment (per ATEC) -Speech/Language/Communication Avg 13.7 (Range:6-25, ATEC max 28) - Sociability Avg 14.6 (Range:2-24, ATEC max 40) -Sensory/Cognitive Awareness Avg 17.7 (Range:10-21, ATEC max 36) -Health Avg 19.3 (Range:8-49, ATEC max 75)

45. Other Information Early onset: 2 Late onset: 10 Family Histories –ADD/ADHD –56% –Learning Disabilities/late speech – 56% –Addiction – 56% –Anxiety and/or Depression – 56%

46. Numbers of Individuals Showing Types of Behavior Problems (as reported by parents) Anxiety 9 Sleep Problems 4 Vocalization11 Socialization12 Schoolwork 9 Tantrums 4

47. Results of Study Number of children completing study: 12 Overall average reduction of autism level: 26 %, after average of 36 sessions Compare with control group (no training): 3% change over 4.5 months

48. Results per ATEC Assessments p <.000 for total change

49. Average Behavior Changes (ATEC) by Type Sociability 33% Speech/language/communication 30% Health 26% Sensory/cognitive awareness 16% p <. 010 for sociability p <.000 for speech p <.015 for health p <. 000 for sensory

50. Behavior Improvement Interview Results

51. Treatment Effectiveness Survey Results 1.Behavior Modification 2.Speech Therapy 3.Occupational Therapy Sensory Integration Neurofeedback *based on parents reports received to date, considering all types of therapies in their experience

52. School Pilot Type of School: private, autistic spectrum focus 1 class –Teacher: maintaining regular tracking, only showing date of NFB start –NFB clinician: ATECs, Spectrals, Behavior notes, parent reports

53. School Pilot Results to Date After 10 sessions –Spectral Changes – Developed installation plans Future School Possibilities –Integrate with other therapies –Include in planning IEP –Begin use with 1-2 behaviors Collect data Move to other behaviors/needs when ready – Include parents

54. Typical Spectral At Beginning After 10 Sessions

55. Protocol Research Simple Placements –Electrode Placement variations –Frequency correlation to behaviors Multiple Placements QEEGs

56. Comments Clinic/School: Develop team to plan individual therapy approach for each child –Initial and periodic reviews by “managing” group/individual –Begin 1 therapy at a time to assess value –Develop decision tree approach as to conditions leading to initial uses of various therapies –Track results Research –Longitudinal Studies –Therapy integration studies –Combined therapy approaches (Speech/NFB, Counseling/NFB, Behavior/NFB) –Impact of Inflammation and stress

57. What you can do for your child Be clear as to assessment of talents, skills, and issues to overcome(Autism – ATEC, Treatment Summary, Full assessment with history, and videos) Determine a method of on-going measurement (per session, per time period) Choose one new approach at a time Measure, measure, measure

58. What you can do for your child Determine impact of and plan accordingly for –Family issues Diet Schedule/Rules –School issues Placement Simultaneous therapies –Social issues

59. Questions References (send e-mail request to bjarus@comcast.net)

60. The End